Attribution and data-integrity boundary

Structured ePCR entries are attributed entries. They assert that this crew performed this act, and where structured data feeds external reporting they become the official record of what the agency provided. Three categories of care therefore belong outside
structured fields and must be carried in full by the narrative: care performed by another agency's provider, care performed before the documenting crew assumed responsibility, and interventions prepared or considered but not performed.

The skill previously modelled only the forward direction of that boundary: structured fields hold what and when, the narrative holds why, do not restate. It had no concept of content deliberately excluded from structured fields. That produced a live defect.
Core Operating Principle 5 would emit "treatments as charted" for an intervention the agency's own standard forbids charting, leaving that intervention documented nowhere.

What changed

• New section: Attribution and Data-Integrity Boundary (SKILL.md, system-prompt.md), including the inversion rule that suspends Core Operating Principles 3 and 5 for narrative-only content.
• Core Operating Principle 1 extended to other clinicians' clinical reasoning. Reasoning is attributed only to the clinician who stated it.
• Core Operating Principle 5 now requires confirming that a structured entry exists before referencing it.
• Medication Administration Standard: prepared-then-withheld doses, including the full waste trail for a controlled substance drawn and not given; medications administered by another provider or before arrival.
• Workflow Step 3: a single attribution prompt covering all three categories, triggered on multi-agency calls, facility-origin transports, and any call where care was in progress on arrival.
• Dictation pocket card: items 1, 2, and 9 updated.
• Primer: new Multi-Agency and Prior-to-Arrival Care Attribution section; the regulatory reporting function added under Purpose; additions to Transfer of Care, the IMIST-AMBO T element, and cardiac arrest documentation.
• Narrative formats: universal inversion rule, quality checklist item 8, and IFT template updated for sending-facility care.
• Agency configuration: new Section 4A, Structured-Field Scope and Attribution Boundary, covering external reporting destinations, waivered or specially authorized acts, and the agency's rules for partner-agency care, prior-to-arrival care, and prepared-but-not-performed interventions.

Waiver, variance, and special-authorization language is deliberately jurisdiction-neutral. What is authorized, by which body, and how it must be reported varies by state and between agencies working the same call, so the rule is stated symmetrically and the agency configuration carries local specifics.

New file: claude-project-instructions.md

The documented Claude setup pasted all of system-prompt.md into a Project's Instructions field while also uploading SKILL.md, duplicating the entire standard. Instructions are re-sent with every message, so users paid roughly 17k tokens per turn for content already retrievable from project files, and the two copies drift apart whenever one is updated.

claude-project-instructions.md carries only what must be in context at all times (non-fabrication, the attribution boundary, PHI, controlled substance and forensic standards, workflow, and the standing disclaimer) and points to the project files for
everything else, at roughly 2.6k tokens.

system-prompt.md remains correct for Gemini Gems, direct API use, and any platform without file retrieval.

Upgrading from 2.0.x

This release replaces the instruction and reference files only. Provider profiles and existing agency configuration files remain valid, though agencies should complete the new Section 4A.

Claude Project users: paste claude-project-instructions.md into the Instructions field over whatever is there now. If your Project currently holds the full system-prompt.md in Instructions, replacing it with this file is the upgrade: same standards, a fraction of the per-message cost. Then remove the old SKILL.md and reference files from Files and upload the new ones. Do not leave both.

Claude Skill package users: download paramedic-narrative.skill below, remove the old skill, and upload the new file.

ChatGPT: replace the Instructions field with the new chatgpt-instructions.md, and replace SKILL.md in Knowledge. Do not leave both.

Gemini: replace your Gem's instructions with the new system-prompt.md.

Microsoft Copilot: update Custom Instructions with the new chatgpt-instructions.md and use the new SKILL.md for your per-session paste.

Full details in the README under Version Control.